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Head Office: Chelab S.r.l., Via Fratta 25 - 31023 Resana (TV)
Phone +39 (0)423.7177 - Fax +39 (0)423.715058
VAT nr. 01500900269, REA Treviso nr. 156079		CHAIN OF CUSTODY FOR GMP SAMPLES
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RESERVED TO THE APPLICANT (SUBMITTER)
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Company nameAddresse-mailPhoneContact person
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Organization/Site for Test Report:
(the Test Report must be send to:)
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Organization for quotation/invoice:
(if different from Organization/Site for Test Report)
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Enclosures:
(enclose MSDS and any relevant document)		Turnaround (or due date requested):Customer purchase number (if any):
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Sampling Site (if different from the Organization/Site for Test Report)Sampling date:Notes:
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Temperature-controlled transport operations (if any)(4)If YES, the temperature-controlled condition is:If YES, the recording Instrument used (if any) is :
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SAMPLES TO ANALYZE TESTS REQUIRED CHELAB'S CHARGE
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Sample name/code/description
(identificative data that have to be reported in the Chelab test reports under 'Sample description' field)		Batch numberExpiry date (if relevant)Nr. of units and/or quantity
Storage conditions(2)Requested TestsProfile code
(unique)		Offer code
(unique)		Notes
(subsidiary informations required for the execution of the test ) (1)		T at receipt (°C)(3)Sample ID
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Date of signature:Name:Signature:
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RESERVED TO CHELABCOMMENTS
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Sample receipt and inspection:Compliance check/issues:
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COURIER:Samples not correctly labeled o identified
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DATE:Lack of physical integrity of received samples
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TEMP.Temperature of sample(s) not consistent with specified transport operations
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SIGNATURE:Missing sample documentation or inconsistent documentation
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Issues notified to Customer Care and samples stored safely
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(1) In the notes section must be specified, when necessary, informations like: specifications and/or labelled values if not already specified in the Quality Agreement, loss on drying or K.F. values (for analysis on the dried or anhydrous basis), acidity index, microbiological test validation number or other informations.
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(2) Without any information flagged we will consider "T = 15-25 °C” as the default storage conditions
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(3) Measure of the surface temperature of the container if the sample must be received refrigerated or frozen or within a defined temperature range.
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(4) If NO is flagged, it means that the quality of the sample/product or the results of the tests commissioned to CHELAB is not compromised as a result of exposure to any temperature conditions during transport operations
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